Human papillomavirus (HPV) and genital warts

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The human
papillomaviruses (HPV) are a family of over 100 strains of virus, of which over
40 can affect the genital area (these strains can also affect the mouth and
throat. Genital warts were the second-most commonly diagnosed STI in the UK in
2012, with especially high rates in young people. Young
gay men have been found to have particularly high rates of anal HPV in some
research. Having HPV has been linked to a higher risk of
becoming infected with HIV in some research.

Some strains of HPV
can lead to cervical or anal cancer. This risk of this is higher in people with
HIV because there is more chance that the virus will become re-activated due to
loss of immunity, although both cervical and anal cancer are relatively rare in
people with HIV. Very rarely, high-risk types of HPV
can also cause vulval, vaginal, penile and some mouth and throat cancers. Being
on HIV treatment, with an undetectable viral load, and having a higher CD4 cell
count (certainly over 200) can reduce the risk of developing HPV-related
cancers.

Transmission

HPV can be contracted
during unprotected anal, vaginal or oral sex, by other close physical contact with the genital
area or by sharing sex toys, even if the infected partner has no obvious
signs or symptoms of HPV. It is possible to have more than one strain of HPV at
any time.

It is possible for a
mother to pass HPV on to her baby during delivery, but this is rare.

Prevention

Using a condom for anal, vaginal and oral sex offers a degree
of protection from infection with HPV, or from passing on the virus to somebody
else. However, protection isn’t complete as the skin around the genital area
may also carry the infection. Don’t share sex toys, or cover them with a condom
or wash them between uses.

People who are
sexually active are advised to have regular sexual health check-ups, where HPV and other sexually transmitted
infections can be tested for. Most HIV treatment centres have an associated
sexual health clinic where free and confidential treatment can be obtained
without referral from your GP or your HIV doctor.

Two vaccines have been
approved that offer protection against certain strains of HPV, including those
that have the highest risk of leading to cervical or anal cancer. In the
UK, vaccination with Gardasil (which
protects against the high-risk HPV strains 16 and 18, as well as 6 and 11,
which cause 90% of genital warts) is currently only available to teenage girls.
Vaccination is likely to have the greatest benefit before young people become sexually active.
If you have already been exposed to the HPV types covered by the vaccine, being
vaccinated will not reduce the risk of future disease caused by HIV. Sexual health experts in the UK have
made a strong argument for the cost-effective public health benefits of
vaccinating young men as well, and the UK's Joint Committee on Vaccination
and Immunisation will make a decision in 2014 when more research has been
completed.

There are no
recommendations about the use of these vaccines in people with HIV. There is
some evidence that there could be health benefits to older gay men being
vaccinated, even if
they have already been infected with one or more of the strains covered by the
vaccination.

It is possible to pay
to have the vaccination as a private patient. If you are considering this, make sure that
you talk to your HIV doctor and have a blood test to see if you are already
infected with the strains of HPV the vaccine protects against.

Symptoms

Most strains of HPV do
not cause obvious symptoms, so people may not realise they have the infection.

Most cases of visible
genital warts are caused by strains 6 and 11. They can take up to a year to
develop after infection takes place. The warts can look and feel much like those
that may appear on other parts of the body – small nodules with either a smooth
or rougher texture. They can appear singly or in ‘cauliflower’-like clusters.
They are usually painless, but can become itchy or inflamed. Occasionally they may
bleed.

In women, warts may
appear on the inside or outside of the vagina, on the neck of the cervix, in or
around the anus and on the thighs. In men, warts may appear on the tip or shaft
of the penis, in or around the anus, on the scrotum or the urethra.

Diagnosis

For women, cervical screening (a smear test) is used to detect pre-cancerous
cellular changes called dysplasia early, before cancer develops. A small sample
of cells from the cervix are examined under a microscope, to see if there are
any changes in the cells which suggest a risk of cervical cancer developing in the future.

HIV-positive women are
recommended to have cervical screening when they are first diagnosed with HIV,
six months later, and then at least once a year.

The value of regular screening of the anal canal for pre-cancerous cells is less clear, and it
is not currently recommended as standard, although some clinics offer it. You
may want to ask about screening, especially if you have already had anal warts.

Genital warts are
diagnosed by visual and manual examination of the genital and anal area.

Treatment

In most cases, the
immune system naturally clears infection with HPV. In some cases, the infection
persists and can cause other health problems, such as warts and cancers.

If you have visible
warts, there are several treatments, none of which cure HPV. Treatment can involve
applying topical creams or liquids, freezing, laser treatment or surgery. These
procedures may feel a little uncomfortable; for some, you will have a local
anaesthetic. Sometimes treatment will need to be repeated, or a combination of different methods used.

HPV vaccination is not
effective against current infections.

If screening shows
that you have developed pre-cancerous cells in your cervix or anus, there is treatment available. If caught early, treatment for these
changes is very effective.

If you are diagnosed
with genital warts, you may be referred to see a health adviser. Health
advisers can give you information about safer sex and how to protect your own
and other people’s sexual health. They may also be able to help you, where
possible or practicable, to contact your sexual partners so they can be tested
or treated if necessary.

For more information

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.